1. First Metatarsophalangeal Joint Arthroscopy for Osteochondral Lesions
Thomas I. Sherman, M.D., Michael Kern, M.D., John Marcel, M.D., Alexander Butler, B.S., Francis X. McGuigan, M.D. 
Arthroscopy Techniques 
Volume 5, Issue 3, Pages e513-e518 (June 2016)
DOI: /j.eats
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2. Fig 1
Nerves adjacent to arthroscopy portals and at greatest risk of iatrogenic injury during establishment of portals. Portals are confirmed with a needle and insufflation before incision.
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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3. Fig 2
Facile method of applying joint distraction to the first metatarsophalangeal joint to facilitate access and visualization. A conforming bandage (Covidien) is looped around the hallux at the level of the first web space and attached to the ankle distractor with a surgical clamp. This can be adjusted as needed intraoperatively.
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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4. Fig 3
Typical appearance of portals and instrumentation use. In this case, the arthroscope is placed in the dorsomedial portal and the shaver in the dorsolateral portal.
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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5. Fig 4
View from the dorsomedial portal showing debridement of the proximal phalanx osteochondral lesion (asterisk) with an arthroscopic curette introduced through this portal.
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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6. Fig 5
View from the dorsomedial portal showing microfracture of the proximal phalanx osteochondral lesion being performed with a K-wire introduced through a medial portal.
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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7. Fig 6
Standardized 13-point arthroscopic examination of the first metatarsophalangeal joint from the dorsolateral or dorsomedial portal: (1) lateral gutter, (2) lateral corner of the metatarsal head, (3) central portion of the metatarsal head, (4) medial portion of the metatarsal head, (5) medial gutter, (6) medial capsular reflection, (7) central bare spot, (8) lateral capsular reflection, (9) medial portion of the proximal phalanx, (10) central portion of the proximal phalanx, (11) lateral portion of the central phalanx, (12) medial sesamoid, and (13) lateral sesamoid. This routine examination helps to confirm that pathology is not missed and that joint visualization and access are sufficient.
(Reproduced with permission from Ferkel et al.7)
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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8. Fig 7
Standardized first metatarsophalangeal joint 5-point examination viewed from the medial portal with the sagittal head removed: (1) posterior plantar capsule, (2) medial and lateral sesamoids, (3) central metatarsal head, (4) superior metatarsal head, and (5) dorsal capsular structures. Visualization of these structures helps to confirm that joint access is sufficient.
(Reproduced with permission from Ferkel et al.7)
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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9. Fig 8
View from the dorsomedial portal showing access to the plantar aspect of the first metatarsophalangeal joint using a 30° arthroscope. The metatarsal head (MT) and phalanx (P) are seen, as is plantar synovial tissue (asterisk).
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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10. Fig 9
Preoperative magnetic resonance imaging of a 26-year-old woman with hallux pain and an osteochondral lesion of the proximal phalanx. (A) Coronal gradient echo-sequence image showing an osteochondral lesion of the proximal phalanx (arrow). (B) Sagittal gradient echo-sequence image showing a chondral defect (asterisk).
Arthroscopy Techniques 2016 5, e513-e518DOI: ( /j.eats )
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